Composite Grafting for Traumatic Fingertip Amputation in Adults: Technique Reinforcement and Experience in 31 Digits

Chen, Shih-Yi; Wang, Chih-Hsin; Fu, Ju-Peng; Chang, Stephen S.; Chen, Shyi-Gen

doi:10.1097/ta.0b013e3181cc8553

Cited by 33 publications

(43 citation statements)

References 33 publications

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“…Mean static 2-PD after skin grafting was 6.5 mm. 14% of our studies (n=6) reported dynamic 2-PD, 26,41–43,55,56 with an overall mean of 7.0 mm; normal range is between 2.8–4.6 mm. 67,68 All six studies were in the local flaps group (e.g.…”

Section: Resultsmentioning

confidence: 70%

“…26,30,31,35,37,54,56 16% of our studies (n=7) evaluated cosmetic satisfaction. 17,21,27,39,43,45,55 85% of patients (112/131) reported “satisfactory” ratings and 98% of patients (105/107) reported “good” or “excellent” ratings, irrespective of treatment. 9% of our studies (n=4) evaluated other PRO measures, such as the Disabilities of the Arm, Shoulder, and Hand (DASH) score.…”

Section: Resultsmentioning

confidence: 99%

“…9% of our studies (n=4) evaluated other PRO measures, such as the Disabilities of the Arm, Shoulder, and Hand (DASH) score. 36,37,54,55 Three of these four studies assessed activities of daily living (ADL) and use of the affected fingertip in ADL. The majority of patients reported no limits on ADL, 54,55 and up to 40% of patients were able to use their affected digits in ADL.…”

Section: Resultsmentioning

confidence: 99%

“…36,37,54,55 Three of these four studies assessed activities of daily living (ADL) and use of the affected fingertip in ADL. The majority of patients reported no limits on ADL, 54,55 and up to 40% of patients were able to use their affected digits in ADL. 37 Patients generally conveyed improved QOL after treatment.…”

Section: Resultsmentioning

confidence: 99%

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A Systematic Review of Outcomes after Revision Amputation for Treatment of Traumatic Finger Amputation

Yuan

McGlinn

Giladi

et al. 2015

Plastic and Reconstructive Surgery

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Background Revision amputations are often the treatment for traumatic finger amputation injuries. However, patient outcomes are inadequately reported, and their impact poorly understood. We performed a systematic review to evaluate outcomes of revision amputations and amputation wound coverage techniques. Methods We searched all available English literature in PubMed and EMBASE for articles reporting outcomes of non-replantation treatments for traumatic finger amputation injuries, including revision amputation, local digital flaps, skin grafting, and conservative treatment. Data extracted were study characteristics, patient demographic data, sensory and functional outcomes, patient-reported outcomes (PROs), and complications. Results 1659 articles were screened, yielding 43 studies for review. Mean static 2-point discrimination (2-PD) was 5.0 ± 1.5 mm (n=23 studies) overall. Mean static 2-PD was 6.1 ± 2.4 mm after local flap procedures and 3.8 ± 0.4 mm after revision amputation. Mean total active motion (TAM) was 93 ± 8% of normal (n=6 studies) overall. Mean TAM was 90 ± 9% of normal after local flap procedures and 95% of normal after revision amputation. 77% of patients report cold intolerance after revision amputation. 91% of patients (217/238) report “satisfactory” or “good/excellent” ratings regardless of treatment. Conclusion Revision amputation and conservative treatments result in better static 2-PD outcomes compared to local flaps. All techniques preserve TAM, although arc of motion is slightly better with revision amputation. Revision amputation procedures are frequently associated with cold intolerance. Patients report “satisfactory,” “good,” or “excellent” ratings in appearance and quality of life with all non-replantation techniques. Level of Evidence III

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Section: Resultsmentioning

confidence: 70%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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A Systematic Review of Outcomes after Revision Amputation for Treatment of Traumatic Finger Amputation

Yuan

McGlinn

Giladi

et al. 2015

Plastic and Reconstructive Surgery

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“…The treatment of digital terminal wound becomes more complicated if the soft tissue defect coexists with phalangeal fracture and tendon tear. 1 Multiple options are available for repairing such defects, including the conservative treatment with the amputation and healing by secondary intention, replantation of fingertip, and fingertip reconstruction using flap transfer.…”

mentioning

confidence: 99%

Distally Based Dorsal Digital Fasciocutaneous Flap for the Repair of Digital Terminal Amputation Defects

Hou¹,

Ju²,

Zhao³

et al. 2013

International Surgery

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The preferred plastic surgery regimen for distal digital segment wounds remains unknown, although multiple options are available for the repair. The purpose of this investigation is to study its anatomic rationale and clinical outcomes, in addition to the role of dorsal digital veins in digital reconstruction. Patients (n = 765) suffering from digital terminal segment traumatic wounds (823 digits) were identified and reviewed in a retrospective manner. The wounds were repaired using distally based dorsal digital fasciocutaneous flaps with venoneuroadipofascial pedicles. Skin flaps survived in 818 digits (99.4%), whereas 5 flaps (0.6%) became partially necrotic. Postoperative follow-up data were available from 521 patients involving 559 digits, for an average duration of 10 months (range, 4-36 months). The wider pedicled fascial flap (1.0-1.5 cm) was significantly associated with a decreased occurrence of blebs, whereas the first few patients with pedicled fascial flaps 0.5 to 1.0 cm wide exhibited more frequent occurrence of blebs and flap contractures. The flaps retracted in size within the first 2 to 3 months at the rate of 10% compared with the intraoperative outlined size. The skin flaps became mildly pigmented within the first postoperative month, and at 6 months the flaps turned brighter in color, almost approximating the color of the normal digits. At 12 months, both the texture and appearance of the flaps were acceptable. The donor sites healed without any scar contracture. The digital terminals appeared grossly normal with acceptable digital function. Without any neural reconstruction, skin flap sensation was rated as S2 to S3+, whereas with neural reconstruction the 2-point discrimination sensitivity measured 4 to 9 mm. The use of a distally based dorsal digital fasciocutaneous flap with venoneuroadipofascial pedicle was a simple, safe, and less invasive regimen for repairing digital terminal segment wounds.

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Composite grafting with pulp adipofascial advancement flaps for treating non‐replantable fingertip amputations

Lai

et al. 2016

Microsurgery

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Composite Grafting for Traumatic Fingertip Amputation in Adults: Technique Reinforcement and Experience in 31 Digits

Cited by 33 publications

References 33 publications

A Systematic Review of Outcomes after Revision Amputation for Treatment of Traumatic Finger Amputation

A Systematic Review of Outcomes after Revision Amputation for Treatment of Traumatic Finger Amputation

Distally Based Dorsal Digital Fasciocutaneous Flap for the Repair of Digital Terminal Amputation Defects

Composite grafting with pulp adipofascial advancement flaps for treating non‐replantable fingertip amputations

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